![]() ![]() Prophylaxis and treatment of peripheral arterial embolism. Prevention of clotting in arterial and cardiac surgery. Treatment of acute and chronic consumptive coagulopathies (disseminated intravascular coagulation). Prevention of postoperative deep venous thrombosis and pulmonary embolism in patients undergoing major abdominothoracic surgery or who, for other reasons, are at risk of developing thromboembolic disease. Prophylaxis and treatment of venous thrombosis and pulmonary embolism. Nursing TIP: A test question asked in the Prophecy entrance assessment administered to new hire nurses in many organizations is "What type of anticoagulant is used for DVT prophylaxis after total knee replacement?” The most frequent incorrect answer is UFH (heparin sodium). Treatment of acute ST-segment elevation myocardial infarction (STEMI) managed medically or with subsequent percutaneous coronary intervention ( 5).Ĭlinical practice guidelines from the American Academy of Orthopedic Surgeons and other organizations recommend using LMWH after total joint surgeries and hip fractures as best practice ( 6). Prophylaxis of ischemic complications of unstable angina and non–Q-wave myocardial infarction (MI). Outpatient treatment of acute DVT without pulmonary embolism. Inpatient treatment of acute DVT with or without pulmonary embolism. Prophylaxis of deep vein thrombosis (DVT) in abdominal surgery, hip replacement surgery, knee replacement surgery, or medical patients with severely restricted mobility during acute illness. The effects of heparin are reversed by the administration of protamine sulfate. A significant advantage of heparin is that it can easily be reversed in the event of surgery or a procedure. In the hospital setting, heparin is often preferred over direct oral anticoagulants, such as warfarin. Indications and Contraindications for Use The twins were each injected withġ mL of heparin drawn from a 10,000 units/mL vial instead ofġ mL of heparin from a 10 units/mL vial ( 4).Ī 23-month-old died after receiving an overdose of heparin during dialysis at the Nebraska Medical Center in Omaha, Nebraska, in 2010.Īccording to the ISMP, "the overdose occurred due to an infusion pump setting error.” The toddler was on a smart pump and the error was not discovered for 5 hours. Similarly, the Quaid twins were overdosed 1000-fold at Cedar-Sinai in Los Angeles in 2007. In a NICU at a hospital in Indiana, six premature infants were injected with a 1000-fold higher heparin dose than intended. Three of the infants died ( 4). Nonetheless, they all involved nursing administration. Typically there are system failures at play in medication errors. Some of these fatal errors are high-profile, and many were found to be associated with manufacturing labeling. The Institute for Safe Medicine Practice (ISMP) identified heparin as one of the top ten medications involved in severe and fatal errors. Dicumarol is the parent of warfarin ( 3). Link extracted dicumarol from the affected hay. ![]() The bleeding disorder was dubbed sweet clover disease. ![]() ![]() He extracted an anticoagulant substance from dog livers ( 2).ĭuring a wet Summer in 1939 in Wisconsin, Karl Link investigated sweet clover hay when cattle ingesting the wet hay hemorrhaged and died. In 1915 he was a second-year medical student at John Hopkins School of Medicine. Jay McLean is widely credited with discovering heparin. Hirudin was extracted from blood-sucking leeches in 1909 due to its anticoagulant properties, but there were production and quality control problems involved in working with leeches ( 2). The history of anticoagulants spans more than a century and includes some interesting and serendipitous discoveries. Leeches, dog livers, and sweet clover hay There are advantages to using LMWH over UFH. Heparin is not administered IM due to risk of hematoma. Heparin sodium, also known as standard heparin. Although both prevent blood clotting, they are used in different situations. There are two types of heparin, low molecular-weight heparin (LMWH) and unfractionated heparin (UFH). Heparin is used to prevent blood from clotting during procedures and prophylactically to prevent patients at risk from forming blood clots. Heparin prevents and treats certain blood vessel, heart, and lung conditions. Heparin does not have fibrinolytic properties, and it does not lyse (dissolve) blood clots. Heparin is both life-saving and life-threatening. Nursing Process: Managing a Patient on Heparin. ![]()
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